Esophagogastric junction outflow obstruction successfully treated with laparoscopic Heller myotomy and Dor fundoplication: First case report in the literature
Esophagogastric junction outflow obstruction (EGJOO) is a rare syndrome, characterized by an elevation of the integrated relaxation pressure of the lower esophageal sphincter, not accompanied by alterations in esophageal motility that may lead to the criteria for achalasia. We were unable to find an...
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| Published in: | World journal of gastrointestinal surgery Vol. 11; no. 2; pp. 112 - 116 |
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| Main Authors: | , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
United States
Baishideng Publishing Group Inc
27-02-2019
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Esophagogastric junction outflow obstruction (EGJOO) is a rare syndrome, characterized by an elevation of the integrated relaxation pressure of the lower esophageal sphincter, not accompanied by alterations in esophageal motility that may lead to the criteria for achalasia. We were unable to find any prior report of the combination of Heller myotomy with anterior partial fundoplication (Dor) as the treatment for EGJOO. We herein report a case of EGJOO treated with laparoscopic Heller myotomy combined with Dor fundoplication.
A 26-year-old man presented with a 3-year history of solid dysphagia and a 30-kg weight loss. He was treated with oral nifedipine, isosorbide, and omeprazole, without resolution of symptoms. An upper gastrointestinal series (barium swallow) revealed a "bird's beak" sign. Esophagogastroduodenoscopy was positive for Los Angeles grade A peptic esophagitis. High-resolution esophageal manometry was compatible with EGJOO. Esophageal pH monitoring showed pathological acid reflux both in orthostatic and decubitus position. An 8-cm laparoscopic Heller myotomy combined with an anterior 220° Dor fundoplication was performed. Solid diet was introduced on postoperative day 2, and the patient was discharged home the same day. At 17-mo follow-up, he reported no symptoms. Barium swallow was compatible with complete radiologic resolution. Both esophageal manometry and upper endoscopy showed normal findings 9 mo after the operation.
Surgical treatment with Heller myotomy and Dor fundoplication is a potential treatment option for EGJOO refractory to medical treatment. |
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| Bibliography: | Supported by Research and Events Support Fund at Hospital de Clí nicas de Porto Alegre. Telephone: +55-51-997721980 Author contributions: Pereira PF, Rosa AR, Mesquita LA, Anzolch MJ, Branchi RN, Giongo AL, Paixão FC, Chedid MF, Kruel CD, contributed with methodology, data acquisition, data presentation and writing of an original draft of the manuscript; Kruel C, Rosa AR and Chedid MF contributed with methodology; conceptualization, and supervision; all authors conducted critical revisions and approved the final version of the manuscript. Corresponding author: Marcio F Chedid, MD, PhD, Professor, Surgeon, Division of Gastrointestinal Surgery and Liver Transplantation, Hospital de Clinicas de Porto Alegre, Medical School of Federal University of Rio Grande do Sul, Rua Ramiro Barcelos 2350, 6th Floor, Room 600, Porto Alegre 90035-903, Brazil. marciochedid@hotmail.com |
| ISSN: | 1948-9366 1948-9366 |
| DOI: | 10.4240/wjgs.v11.i2.112 |